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3. Nutritional Requirements
Throughout the Lifecycle
Session 3 Nutritional Requirements Throughout the Lifecycle....................................4
Introduction................................................................................................................4
Learning Outcomes for Study Session 3....................................................................4
3.1 Why it is imortant to !no" nutritional requirements........................................4
3.# Nutrition during regnancy and lactation...........................................................$
%o& 3.1 Increased nutrients required during regnancy.......................................$
3.#.1 'aining "eight in regnancy.......................................................................(
)uestion.................................................................................................................*
+ns"er...................................................................................................................*
3.#.# ,ating during regnancy..............................................................................*
3.#.3 -reenting anaemia in regnancy................................................................/
3.#.4 -regnant "omen "ith secial needs............................................................/
%o& 3.# Identifying and heling regnant "omen "ho need secial hel....... ..../
)uestion.................................................................................................................0
+ns"er...................................................................................................................0
)uestion.................................................................................................................0
+ns"er...................................................................................................................0
3.3 Nutrition during lactation 2reastfeeding...........................................................0
%o& 3.3 Increased nutrients required during lactation........................................1
3.4 Nutritional requirements in infancy5 childhood and adolescence.....................1
3.4.1 +dolescent gro"th surt............................................................................1
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3.4.# Increased need for nutrients.......................................................................11
,nergy..................................................................................................................11
Water....................................................................................................................11
,ssential fatty acids..............................................................................................1#
%o& 3.4 Increased nutrients required during infancy5 childhood and adolescence
..............................................................................................................................1#
3.$ Nutritional requirements during adulthood.......................................................1#
3.( Nutritional requirements during later years......................................................1#
%o& 3.$ -ossi2le nutritional issues in old age.....................................................1#
3.(.1 Secific nutrient requirements in old age...................................................13
3.* Nutritional requirements throughout the life cycle6 conclusion........................13
,lderly eole......................................................................................................13
7en......................................................................................................................14
Women.................................................................................................................1$
+dolescents..........................................................................................................1(
School aged children............................................................................................1*
8hildren 19$ years old.........................................................................................1/
%a2ies (:1# months..............................................................................................10
%a2ies under ( months old...................................................................................#
Self:+ssessment )uestions S+)s for Study Session 3.........................................#
S+) 3.1 tests Learning Outcomes 3.1 and 3.#..................................................#1
+ns"er.................................................................................................................#1
S+) 3.# tests Learning Outcomes 3.# and 3.3..................................................#1
+ns"er.................................................................................................................#1
S+) 3.3 tests Learning Outcomes 3.3 and 3.$..................................................#1
+ns"er.................................................................................................................#1
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S+) 3.4 tests Learning Outcomes 3.1 and 3.4..................................................##
+ns"er.................................................................................................................##
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Session 3 Nutritional Requirements
Throughout the Lifecycle
Introduction
In the reious t"o sessions5 you learnt a2out food5 diet and nutrients as "ell as the
food sources of the different nutrients.
In this session you "ill learn a2out the nutritional needs at different stages of the
lifecycle. The nutrient requirements during the four main stages of the human
lifecycle ary considera2ly. What infants and children require is different from "hat
adults and the elderly need. In addition5 there might 2e secific nutrients "hich a
regnant "omen and lactating mothers need in higher amounts than adult men.
Therefore5 as a ;ealth ,&tension -ractitioner5 this study session "ill hel you to giethe aroriate messages to different oulation grous.
Learning Outcomes for Study Session 3
When you hae studied this session5 you should 2e a2le to6
3.1 or
reasons6
Prescriptive reasons6 that is5 to roide or disense food sulies? for e&amle6
• to rocure food for national consumtion
• to secure food for institutional consumtion
• to run nutritional sulementation rogrammes.
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Diagnostic reasons6 mainly to identify "hether a grou or an indiidual is suffering
from malnutrition of any !ind? for e&amle6
• to ealuate nutritional interention rogrammes
• to determine "hether the food aaila2le in the stoc! is adequate to feed thehousehold or nation for a certain duration of time.
In order to estimate nutritional requirements of indiiduals or grous5 "e need to
consider the follo"ing factors6
• -hysical actiity @ "hether a erson is engaged in heay hysical actiity
• The age and se& of the indiidual or grou
• %ody siAe and comosition @ "hat the general 2uild is of a erson or grou
• 8limate @ "hether a erson or grou is liing in hot or cold climate
• -hysiological states5 such as regnancy and lactation.
%ased on these factors5 nutritional requirements in the different segments of the
oulation can 2e classified into four grous. These corresond to different arts of
the lifesan5 namely a regnancy and lactation5 2 infancy and childhood c
adolescence and adulthood5 and d old age. =ou are no" going to loo! at each of
these in turn.
3.# Nutrition during regnancy and lactation
+n un2orn child needs a healthy and "ell:nourished mother to gro" roerly.
Therefore5 a mother needs to gain "eight during regnancy to hel nourish her
gro"ing 2a2y. Women "ho do not gain enough "eight often hae 2a2ies that "eigh
too little lo" birth "eight. + 2a2y "eighing less than #.$ !g has an increased
chance of 2oth hysical and mental health ro2lems. It may also suffer more from
infection and malnutrition comared "ith 2a2ies of normal "eight. The increased
requirement of nutrients during regnancy and lactation is sho"n in %o& 3.1.
$o% 3.1 Increased nutrients required during regnancy
Increased requirements6 energy5 rotein5 essential fatty acids5 itamin +5 itamin 85
% itamins %15 %#5 %35 %$5 %(5 %1#5 folate5 calcium5 hoshorus5 iron5 Ainc5 coer
and iodine.
Women should gain at least 11 !g during regnancy Bigure 3.1. If the mother gains
less than this5 the 2a2yCs chances of surial and health declines. If a mother is
oer"eight5 she still needs to gain for her 2a2yCs health. She should not try to lose
"eight "hile she is regnant.
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Bigure 3.1 'aining "eight during regnancy.
3.#.1 &aining "eight in regnancy
+ regnant mother should gain "eight smoothly and steadily. If "eight gain occurssuddenly5 she should see a health rofessional.
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•
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• -regnant "omen during the third trimester of regnancy should 2e de:"ormed
using me2endaAole or al2endaAole you "ill learn a2out the doses for this in
Study Session * of this 7odule.
• -regnant "omen need a "ell 2alanced diet containing mi&ture of foods. This
should include as far as ossi2le food from the different food grous animal roducts5 fruits5 egeta2les5 cereals and legumes.
Remem2er5 there is no need for high:riced foodsG + regnant or lactating "oman can
get e&tra foods 2y eating a little more of ordinary meals. She should increase the
amount of nourishment at one or t"o meals5 not eery meal.
3.#.3 *re+enting anaemia in regnancy
Some "omen feel "ea! and tired "hen regnant. They may 2e anaemic5 "hich in
turn means that they may hae difficulty in regnancy and child2irth. 8ommon
ro2lems lin!ed to the motherCs anaemia include6
• %a2ies "ill 2e 2orn "ithout three to si& months iron suly
• %reastmil! may hae insufficient iron.
+ regnant or 2reastfeeding mother should hae enough iron to !ee herself and her
2a2y healthy. She should eat lenty of iron:rich foods eery day such as dried 2eans5
legumes5 dar! green leafy egeta2les5 lier5 !idney and heart.
+ regnant mother should go for her first antenatal care isit at the latest 2y the fourthmonth of her regnancy. +t the clinic5 chec! her urine for e&cess sugar and roteins5
and her 2lood for malaria if she is sho"ing signs of infection.
=ou diagnose anaemia in the follo"ing "ay6
,&amine the lo"er eyelids5 the inside of the lis and the alms "hich should 2e 2right
in!? if there is anaemia5 all of these "ill 2e ale "hitish.
• 'ie the mother iron ta2lets or ta2lets "ith iron and folate to 2uild strong
2lood
• Remind the mother to ta!e the ta2lets after a main meal. She should not ta!eiron ta2lets "ith tea5 coffee or mil!
• If the iron ta2lets uset the mother or cause side effects5 she should not sto
ta!ing iron5 2ut eat more leafy egeta2les.
3.#., *regnant "omen "ith secial needs
Some regnant "omen in your community "ill 2e articularly ulnera2le. +s a
;ealth ,&tension -ractitioner it is imortant that you identify the "omen "ho may
need e&tra hel and suort. %o& 3.# gies e&amles of "omen "ho may need secialhel from you and outlines the !inds of serice you can roide for them.
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$o% 3.# Identifying and heling regnant "omen "ho need secial
hel
*regnant "omen "ho might need secial hel include-
• Women from oor families5 or "ho are unemloyed
• Women "ho are "ido"sEsearated5 and hae no suort
• 7others "ho hae gien 2irth to many 2a2ies oer a short time
• Women "ho are ill from diseases li!e Tu2erculosis T%
• Women "ho loo! thin and deressed
• 7others "hose reious 2a2ies "ere small and malnourished
• Teenagers
• Women "ith a history of their 2a2y or 2a2ies dying in their first year of life
• 7others oer2urdened "ith "or!
• 7others "ho are ery "orried5 articularly first time regnancies.
The ealth )%tension *ractitioner/s role-
• Hisit the regnant "omen often• ,ncourage them to eat as good mi&ture of foods as they can afford fruits5
egeta2les5 animal source foods
• Let them 2e the first ones to receie iron or food sulements5 "hen aaila2le
• ;el them to get roer healthcare
• ,ncourage other mem2ers of the household to do some of the "or! and lessen
the "or! 2urden on the "oman.
'uestion
What are the effects of lo" maternal iron leel for the 2a2y and mother in regnancyD
(ns"er
The mother "ill hae difficulty during child2irth and regnancy. The 2a2y of an
anaemic mother "ill not deelo "ell and "ill hae lo" 2irth "eight. The 2a2y "ill
then 2e easily affected 2y different infections.
,nd of ans"er
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'uestion
Which arts of the 2ody should you e&amine to find out "hether a regnant "oman is
anaemic or notD
(ns"er
=ou should e&amine the lo"er eyelids5 inside of the lis and the alms of the hand. If
there is anaemia5 they "ill 2e ale "hitish? if there is no anaemia they "ill 2e in!ish.
,nd of ans"er
3.3 Nutrition during lactation 0breastfeeding
If all 2a2ies are to 2e healthy and gro" "ell5 they must 2e fed 2reastmil!. When a
2a2y suc!s at the nile5 this causes the mil! to come into the 2reast and continue toflo". %reastmil! is food roduced 2y the motherCs 2ody esecially for the 2a2y5 and it
contains all the nutrients nourishment a healthy 2a2y needs.
+ lactating "oman needs at least t"o e&tra meals $$ Fcal of "hateer is aaila2le
at home. In addition a dose of itamin + #5I should 2e gien once 2et"een
deliery and si& "ee!s after deliery. This "ill ena2le the 2a2y to get an adequate
suly of itamin + for the first si& months.
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The common feature of infancy5 childhood and adolescence is that all these age
grous are undergoing raid gro"th and deeloment. This in turn oses a heay
demand on their nutritional requirements. Small children and infants do not hae a
"ell deeloed 2ody nutrient store5 and therefore are more ulnera2le to infection. In
addition they hae a larger surface area comared to their 2ody siAe. +ll these factors
increase their 2asal meta2olic rate %7R5 resulting in an increased requirement fornutrients.
3.,.1 (dolescent gro"th surt
+dolescents also undergo a ery raid gro"th during their u2erty called the
ubertal gro"th surt.
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• 8ar2ohydrate lactose J (.09*.#K
• 7ineral J .#K
• -rotein J ./9.0K
;igher inta!es of rotein and energy for gro"th are recommended for adolescents.
Bor most micronutrients5 recommendations are the same as for adults. ,&cetions are
made for certain minerals needed for 2one gro"th e.g. calcium and hoshorus.
,idence is clear that 2one calcium accretion increases as a result of e&ercise rather
than from increases in calcium inta!e. Since "eight gain often 2egins during
adolescence and young adulthood5 young eole must esta2lish healthy eating and
lifestyle ha2its that reduce the ris! for chronic disease later in life.
Water
Infants and children need lenty of "ater to drin!5 articularly "hen ill5 or e&osed to
e&treme temeratures.
Total "ater requirements from 2eerages and foods are also higher in infants and
children than for adults. 8hildren hae a larger 2ody surface area er unit of 2ody
"eight and a reduced caacity for s"eating "hen comared "ith adults5 and therefore
are at greater ris! of mor2idity and mortality from dehydration. -arents may
underestimate these fluid needs5 esecially if infants and children are e&eriencing
feer5 diarrhoea or e&osure to ery cold or ery hot temeratures.
)ssential fatty acids
Requirements for fatty acids or fats on a er !ilogram 2asis are higher in infants than
adults see %o& 3.4. Some fatty acids lay a !ey role in the central nerous system.
;o"eer infants and children should not ingest large amounts of foods that contain
redominantly fats5 so it is imortant to get the 2alance right.
$o% 3., Increased nutrients required during infancy2 childhood and
adolescence
Infancy and childhood
Increased requirements of energy5 rotein5 essential fatty acids5 calcium and
hoshorus.
(dolescence
Increased requirements of energy5 rotein5 calcium5 hoshorus and Ainc.
3. Nutritional requirements during adulthood
1#
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The nutritional needs in adults of 109$ years of age differ slightly according to
gender. 7ales require more of itamins 85 F5 %15 %# and %35 and Ainc. Bemales
require more iron5 comared "ith males of similar age.
=ou hae already seen that regnant "omen and lactating mothers hae articular
nutrient requirements that are necessary for their o"n health as "ell as the health oftheir 2a2y.
3.4 Nutritional requirements during later years
,lderly eole are esecially ulnera2le to nutritional ro2lems due to age related
changes in their 2ody imaired hysiological and anatomical caacity. %o& 3.$
oerleaf sets out some of the ro2lems an older erson might e&erience "hich could
imact on their diet.
$o% 3. *ossible nutritional issues in old age
• -ro2lems of rocuring and rearing foods
• -sychosocial ro2lems
• oints.
3.4.1 Secific nutrient requirements in old age
+n elderly erson requires less energy than a younger indiidual due to reductions in
muscle mass and hysical actiity. Some daily requirements for elderly eole differ
from those of younger adults. Bor e&amle5 in order to reduce the ris! for age related 2one loss and fracture5 the requirement for itamin < is increased from # IEday to
4 in indiiduals of $19* years of age and to ( IEday for those oer * years of
age. Suggested iron inta!es reduce ho"eer from 1/ mg er day in "omen aged 109
$ to / mgEday after age $5 due to 2etter iron conseration and decreased losses in
ostmenoausal "omen comared "ith younger "omen.
Some elderly eole hae difficulty getting adequate nutrition 2ecause of age or
disease related imairments in che"ing5 s"allo"ing5 digesting and a2sor2ing
nutrients. Their nutrient status may also 2e affected 2y decreased roduction of
chemicals to digest food digestie enAymes5 changes in the cells of the 2o"el
surface and drug9nutrient interactions. Some elderly eole demonstrate seleniumdeficiency5 a mineral imortant for immune function. Imaired immune function
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affects susceti2ility to infections and tumours malignancies. Hitamin %( hels to
2oost selenium leels5 so a higher inta!e for eole aged $19* is recommended.
Nutritional interentions should first emhasise healthy foods5 "ith sulements
laying a secondary role. +lthough modest sulementary doses of micronutrients can
2oth reent deficiency and suort immune functions5 ery high dosesulementation e&amle5 high dose Ainc may hae the oosite effect and result in
immune:suression. Therefore5 elderly eole also need secial attention "ith regard
to nutritional care.
3.5 Nutritional requirements throughout the life
cycle- conclusion
Requirements for energy and micronutrients change throughout the life cycle.
+lthough inadequate inta!e of certain micronutrients is a concern5 ro2lems also
come from the dietary e&cesses of energy5 saturated fat5 cholesterol and eating refinedcar2ohydrates5 all of "hich are contri2uting to o2esity and chronic disease in
deeloed countries. %elo" is a summary of the num2er of meals required at different
stages in the lifecycle that might assist you in your "or! in your community.
)lderly eole
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Need at least t"o and if ossi2le more meals each day as they may not eat much at
each meal. They need fe"er calories than younger eole5 2ut a2out the same amount
of rotein and other nutrients. Women "ho hae stoed menstruating need less iron
than child2earing "omen. Old eole may need soft food.
6en
1$
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Need at least t"o mi&ed meals eery day and some snac!s. They can get enough
energy from fe" large meals and from 2ul!y food.
Women
1(
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Need at least t"o mi&ed meals eery day and some snac!s. If they are regnant or
lactating they need as almost as much food as men5 esecially if they are also doing
hard hysical "or!. They need much more iron and folate than men esecially "hen
they are regnant.
(dolescents
Need at least t"o large mi&ed meals and some snac!s each day. They can eat 2ul!y
food. %oys need a lot of calories. 'irls need lenty of iron. -regnant adolescent girls
are still gro"ing so they need more food than regnant "omen.
1*
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School aged children
Need at least t"o to three mi&ed meals and some snac!s each day.
7hildren 18 years old
1/
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Need 2reastmil! until they are at least t"o years old. They need at least three mi&ed
meals and t"o snac!s each day. They cannot eat large 2ul!y meals. It is esecially
imortant for the meals to 2e clean and not to contain arasites or microorganisms
that could cause diarrhoea or other infection.
$abies 491# months
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Need 2reastmil! eight to ten times or more each day. They need small meals5 "hich
are not 2ul!y5 three to fie times a day.
$abies under 4 months old
Need only 2reastmil! at least eight to ten times each day.
+s a ;ealth ,&tension -ractitioner5 you can assist families in choosing foods that
!ees energy inta!e "ithin reasona2le 2ounds5 "hile ma&imising inta!e of nutrient:
rich foods5 articularly egeta2les5 fruits5 legumes and "hole grains.
Self9(ssessment 'uestions 0S('s for Study Session 3
#
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No" that you hae comleted this study session5 you can assess ho" "ell you hae
achieed its Learning Outcomes 2y ans"ering the questions 2elo". Write your
ans"ers in your Study
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• 8hildren hae huge energy requirements so need more calories than older
eole
• 8hildren need more "ater 2ecause they are at greater ris! of dehydration
• Older eole might hae hysical ro2lems "hich ma!e eating difficult
• Older eole need more itamin